Prevalence of noncaesarean uterine surgical scars in a maternity population

NHMR

Variation in hospital caesarean section rates for women with at least one previous caesarean section: a population based cohort study

Background: Internationally, repeat caesarean sections (Robson Classification Group 5) make the single largest contribution to overall caesarean section rates and hospital-to-hospital variation has been reported. It is unknown if case-mix and hospital factors explain variation in hospital rates of repeat caesarean sections and whether these rates are associated with maternal and neonatal morbidity. Methods: This population-based record linkage study utilised data from New South Wales, Australia between 2007 and 2011. The study population included all maternities with prior caesarean section that were singleton, cephalic and at term. Multilevel regression models were used with primary outcomes of ‘planned repeat caesarean section’ and ‘intra-partum caesarean section’. The associations between quintiles of risk-adjusted hospital rates of planned and intra-partum repeat caesarean sections and case-mix adjusted maternal and neonatal morbidity rates, postpartum haemorrhage rates and Apgar score below 7 at five minutes rates were also assessed. Results: Of 61894 maternities with a prior caesarean section in 81 hospitals, 82.1% resulted in a repeat caesarean section and 17.9% in vaginal birth. Of the caesarean sections, 72.7% were planned and 9.4% were unplanned intra-partum. Crude hospital rates of planned caesarean sections ranged from 50.7% to 98.4%. Overall 49.0% of between-hospital variation in planned repeat caesarean section rates was explained by patient characteristics (17.3%) and hospital factors (31.7%). Increased odds of planned caesarean section were associated with private hospital status and lower hospital propensity for vaginal birth after caesarean. There were no associations between quintiles of planned repeat caesarean section and adjusted morbidity rates. Crude rates of intra-partum caesarean section ranged from 12.9% to 71.9%. In total, 27.5% of between hospital variation in rates of intra-partum caesarean section was explained by patient (19.5%) and hospital factors (8.0%). The adjusted morbidity rates differed among quintiles of hospital intra-partum caesarean section rates, but were influenced by a few hospitals with outlying rates. 3 Conclusions: About half of the variation in hospital planned repeat caesarean section rates was explained and strategies aimed at modifying these rates should not affect morbidity rates. Intra-partum caesarean sections were associated with morbidity but not in a systematic mannerNHMRC, AR

Horse owners' biosecurity practices following the first equine influenza outbreak in Australia

A cross-sectional study was conducted involving 759 Australian horse owners to determine their biosecurity practices and perceptions one year after the 2007 equine influenza outbreak and to investigate the factors influencing these perceptions and practices. A web link to an online questionnaire was sent to 1224 horse owners as a follow-up to a previous study to obtain information about biosecurity perceptions and practices, impacts of the 2007 EI outbreak, demographic information and information about horse industry involvement. Ordinal logistic regression analyses were conducted to determine factors associated with poor biosecurity practices. Biosecurity compliance (low, medium, high), as determined by horse owners’ responses to a 16-item question on the frequency of various biosecurity measures, was used as the outcome variable in ordinal logistic regression analyses. Variables with a univariable p-value ≤0.2 were eligible for inclusion in multivariable models built using a manual stepwise approach. Variables with a p-value <0.05 in multivariable models were retained in the final model. Two potential confounders - age and gender of participants- were included in the final model irrespective of their p-values. Thirty percent of the respondents had low biosecurity compliance and were performing biosecurity practices ‘not very often’ or ‘never’. Younger people, people with two or more children, those who were not involved with horses commercially and those who had no long-term business impacts resulting from the 2007 EI outbreak were more likely to have lower biosecurity compliance. People who were not fearful of a future outbreak of equine influenza in Australia and those who thought their current hygiene and access control practices were not very effective in protecting their horses also had poor biosecurity practices. In this observational study we identified factors associated with a group of horse owners with low levels of biosecurity compliance. As this cross-sectional study only assesses associations, the identified factors should be further investigated in order to be considered in the design of extension activities to increase horse owners’ biosecurity compliance. Keywords: Biosecurity; Equine; Owner perceptions; Ordinal logistic regression

Survey of Australian equine veterinarians evaluating their biosecurity training and perceptions and opinions about the management of the 2007 equine influenza outbreak

Objectives To evaluate the level of biosecurity training among Australian equine veterinarians, to assess their biosecurity and infectious disease perceptions and their opinions about the 2007 equine influenza outbreak management. Design Cross sectional study. Procedure A survey was conducted among equine veterinarians attending the 2010 annual conference of the Equine Veterinarian Association (EVA) in Australia. Data were collected using a selfcompleted questionnaire and analysed using Fisher’s exact tests to assess veterinarians’ level of biosecurity training, infectious disease perceptions and views regarding the 2007 equine influenza outbreak management. Results A total of 46 out of the 196 attending veterinarians (23.5%) completed the questionnaire. Significantly greater proportions of recently graduated veterinarians received theoretical and practical biosecurity training at veterinary schools than their counterparts The majority considered their likelihood of spreading infectious diseases from one client’s horse to another to be low (84%). More than half (58%) of the veterinarians considered that hand-washing/ wearing gloves was very effective in preventing disease spread. However, around a quarter (27%) reported a degree of reservation about the practicality of performing general biosecurity practices in everyday working life. Overall veterinarians were satisfied with the equine influenza outbreak response but had mixed opinions about the control measures used and communications. Conclusion Levels of biosecurity training and the frequency of biosecurity advice provided by veterinarians have increased over time, although practicality of biosecurity practices is a concern for some of the veterinarians. Further investigations of the barriers for the use of various biosecurity practices are required in order to inform training programs. Keywords: equine, veterinarians, biosecurity, perceptions, equine influenza, training.financial support of the Rural Industries, Research and Development Corporation (RIRDC

Variation in and factors associated with timing of low risk, pre-labour repeat caesarean sections in NSW, 2008-2011

In April 2007, the New South Wales (NSW) Ministry of Health released an evidence-based policy directive requiring that ‘where there are no compelling medical indications, elective or pre-labour caesarean section does not occur prior to 39 completed week’s gestation’. This study describes variation in and factors associated with hospital rates of early (37-38 weeks gestation), low risk pre-labour repeat caesarean section at term. Linked birth and hospital data for low-risk, pre-labour repeat caesarean sections in NSW in 2008-2011 were analysed using multi-level regression modelling. Rates were adjusted for casemix and hospital factors. In 2008-2011, there were 15,163 pre-labour repeat caesarean sections among low risk women in NSW. Overall, 34.7% of low risk pre-labour repeat caesarean sections occurred before 39 weeks gestation. Casemix and hospital factor adjusted NSW public hospital rates of early (37-38 weeks gestation), low risk, pre-labour repeat caesarean section at term varied widely (16.3%-67.5%). Smoking, private health care, assisted reproductive technology, higher parity, a non-caesarean uterine scar and delivering in a hospital with CPAP facilities were associated with higher odds of early delivery. Hospitals with higher rates of low risk deliveries and higher propensity for vaginal birth after caesarean rates had lower odds of early delivery. The findings suggest poor uptake of the policy for pre-labour caesarean from 39 weeks. Large between-hospital variation persisted following adjustment, suggesting that non-medical factors are related to timing of low risk, pre-labour caesarean section. Further strategies are needed to enhance adherence to evidence-based policy.ARC, NHMR

Controlling Equine Influenza: Policy Networks and Decision-Making During the 2007 Australian Equine Influenza Outbreak.

Rapid, evidence-based decision-making is critical during a disease outbreak response however compliance by stakeholders is necessary to ensure that such decisions are effective – especially if the response depends on voluntary action. This mixed method study evaluated technical policy decision-making processes during the 2007 outbreak of equine influenza in Australia by identifying and analysing the stakeholder network involved and the factors driving policy decision-making. The study started with a review of the outbreak literature and published policy documents. This identified six policy issues regarding policy modifications or differing interpretations by different state agencies. Data on factors influencing the decision-making process for these six issues and on stakeholder interaction were collected using a pre-tested, semi-structured questionnaire. Face-to-face interviews were conducted with 24 individuals representing 12 industry and government organisations. Quantitative data were analysed using social network analysis. Qualitative data were coded and patterns matched to test a pre-determined general theory using a method called theory-oriented process-tracing. Results revealed that technical policy decisions were framed by social, political, financial, strategic and operational considerations. Industry stakeholders had influence through formal pre-existing channels, yet specific gaps in stakeholder interaction were overcome by reactive alliances formed during the outbreak response but outside the established system. Overall, the crisis management system and response was seen as positive and 75100% of individuals interviewed were supportive of, had interest in and considered the outcome as good for the majority of policy decisions, yet only 4675% of those interviewed considered that they had influence on these decisions. Training to increase awareness and knowledge of emergency animal diseases and response systems will improve stakeholder participation in emergency disease management and preparedness for future emergency animal disease incursions. Key words: emergency animal disease outbreak, policy decision-making, equine influenza, risk management, preparednessfinancial support of the Rural Industries Research and Development Corporation (RIRDC

Horse owners'/managers' perceptions about effectiveness of biosecurity measures based on their experiences during the 2007 equine influenza outbreak in Australia.

Following the first ever equine influenza outbreak in Australia in 2007, a study was conducted involving 200 horse owners and managers to determine their perceptions about effectiveness of biosecurity measures and the factors associated with these perceptions. Face-to-face interviews were conducted with horse owners/managers to obtain information about their perceptions of the effectiveness of biosecurity practices, their sources of information about infection control during the outbreak and their horse industry involvement. Two outcome variables were created from horse owners’ responses to a 17-item question on the perceived effectiveness of various recommended equine influenza biosecurity measures: (a) a binary outcome variable (Low/High biosecurity effectiveness) and (b) a continuous outcome variable (the proportion of the 17 measures considered ‘very effective’). These outcomes were used in binomial logistic and linear regression analyses, respectively, to determine factors associated with perceptions of biosecurity effectiveness. Variables with a p-value <0.05 in multivariable models were retained in the final models. The majority (83%) of the 200 horse owners and managers interviewed believed that more than half of the recommended equine influenza biosecurity measures were very effective for protecting their horses from equine influenza infection in the event of a future outbreak. Interviewees that were more likely to judge on-farm biosecurity measures as effective were those who received infection control information from a veterinarian during the outbreak, did not experience equine influenza infection in their horses, and those on small acreage premises (homes with horses on site). Greater levels of preparedness for a future equine influenza outbreak and greater interest in information about infection control were associated with a better perception about effectiveness of biosecurity measures. This study identified factors associated with horse owners’ and managers' perception of effectiveness of biosecurity measures. These findings should be considered in the design of infection control programs. Keywords: Biosecurity practices Equine Equine influenza Owner perceptions Behaviour change Regression analysisThe Rural Industries Research and Development Corporation (RIRDC) funded the projec

Horse owners'/managers' perceptions about effectiveness of biosecurity measures based on their experiences during the 2007 equine influenza outbreak in Australia.

Following the first ever equine influenza outbreak in Australia in 2007, a study was conducted involving 200 horse owners and managers to determine their perceptions about effectiveness of biosecurity measures and the factors associated with these perceptions. Face-to-face interviews were conducted with horse owners/managers to obtain information about their perceptions of the effectiveness of biosecurity practices, their sources of information about infection control during the outbreak and their horse industry involvement. Two outcome variables were created from horse owners’ responses to a 17-item question on the perceived effectiveness of various recommended equine influenza biosecurity measures: (a) a binary outcome variable (Low/High biosecurity effectiveness) and (b) a continuous outcome variable (the proportion of the 17 measures considered ‘very effective’). These outcomes were used in binomial logistic and linear regression analyses, respectively, to determine factors associated with perceptions of biosecurity effectiveness. Variables with a p-value <0.05 in multivariable models were retained in the final models. The majority (83%) of the 200 horse owners and managers interviewed believed that more than half of the recommended equine influenza biosecurity measures were very effective for protecting their horses from equine influenza infection in the event of a future outbreak. Interviewees that were more likely to judge on-farm biosecurity measures as effective were those who received infection control information from a veterinarian during the outbreak, did not experience equine influenza infection in their horses, and those on small acreage premises (homes with horses on site). Greater levels of preparedness for a future equine influenza outbreak and greater interest in information about infection control were associated with a better perception about effectiveness of biosecurity measures. This study identified factors associated with horse owners’ and managers' perception of effectiveness of biosecurity measures. These findings should be considered in the design of infection control programs. Keywords: Biosecurity practices Equine Equine influenza Owner perceptions Behaviour change Regression analysisThe Rural Industries Research and Development Corporation (RIRDC) funded the projec

An opportunistic pilot study of radiographs of equine nasal bones at the usual site of nosebands

Restrictive nosebands are of growing concern because of their potential effect on equine welfare. This study evaluates archived radiographs of equine nasal bones for evidence of trauma and to test whether age, sex, or breed were risk factors for such radiographic changes. Radiographs of equine nasal bones (n = 60) were studied for evidence of bony or soft tissue changes by a specialist radiologist blinded to their signalment. Horses with described changes were classified as possible cases and horses without changes, non-cases. The possible cases (n = 9) were discussed with a second specialist radiologist following which the first radiologist reclassified 3 possible cases as non-cases. Radiographs were matched to the age, sex, and breed of each horse and associations with being a case were assessed using Fisher\u27s exact tests. Of 60 horses assessed, 50% of Warmbloods (3/6), 11% of Thoroughbreds (2/18), and 20% of Australian Stock Horses (1/5) were cases. Warmbloods had a greater proportion of changes than other breeds (P = 0.01). There were no statistically significant sex or age associations. The radiologists disagreed as to whether some changes were within normal anatomical variation or were radiographic artifacts but agreed that assessing equine nasal bones using existing radiographs was surprisingly difficult due to issues such as inconsistent radiographic technique and equipment, obliquity of many of the radiographs, and lack of objective data as to what comprises normal nasal bones. Further radiographic studies in this domain should consider the merits of a prospective sample, establish consistent radiography protocols, and aim to establish normality, perhaps by studying a control population that has not had human interventions, such as Australian wild brumbies